血清HBV RNA在慢性乙型肝炎抗病毒治疗过程中的动态变化及其临床意义  

Dynamic changes and clinical significance of serum HBV RNA in patients with chronic hepatitis B during antiviral therapy

作　　者：张荣芳 钱磊[1] 常明杰 付兵利 郭利敏[3] ZHANG Rong-fang;QIAN Lei;CHANG Ming-jie;FU Bing-li;GUO Li-min(Department of Clinical Laboratory,83rd Army Group Military Hospital,The People′s Liberation Army of China,Xinxiang 453000,China;Department of Clinical Laboratory,Huanxing Cancer Hospital,Chaoyang District of Beijing,Beijing 100020,China;Department of Clinical Laboratory,Xinxiang Central Hospital,Xinxiang 453000,China)

机构地区：[1]中国人民解放军陆军第八十三集团军医院检验科,新乡453000 [2]北京市朝阳区桓兴肿瘤医院检验科,北京100020 [3]新乡市中心医院检验科,新乡453000

出　　处：《天津医科大学学报》2021年第5期520-523,共4页Journal of Tianjin Medical University

摘　　要：目的:探讨血清HBV RNA在慢性乙型肝炎(CHB)抗病毒治疗过程中的动态变化及其临床意义。方法:慢性乙型肝炎患者62例采用恩替卡韦抗病毒治疗,分别在第0、7、14、30天以及第2、3、6、9、12个月来本院进行随访,TaqMan探针法定量检测HBV RNA水平,采用实时荧光定量PCR法进行HBV DNA水平检测,采用化学发光法进行HBsAg和HBeAg检测,采用酶法进行ALT及AST检测。结果:血清HBV RNA水平随着治疗时间的延长呈下降趋势,治疗3个月后下降速度趋缓,从9个月后变化不大。血清HBV RNA水平从0 d到6个月间,各个相邻监测点间变化均有统计学意义(均P<0.05),在治疗6~12个月两个时间点间差异无统计学意义(P>0.05)。HBeAg(+)患者基线血清HBV RNA与HBV DNA(r_(s)=0.68,P<0.05)、HbsAg(r_(s)=0.64,P<0.05)、HBeAg(r_(s)=0.77,P<0.05)均强相关。在治疗前6个月各时间点,HBV RNA与HBV DNA呈强相关(r_(s)>0.5,P<0.05)。HBV RNA与HBsAg在治疗前3个月呈强相关(r_(s)>0.5,P<0.05),治疗6~9个月时为弱相关(r_(s)=0.23,P=0.31;r_(s)=0.28,P=0.23)。HBV RNA与HBeAg水平在各治疗时间点均为强相关(r_(s)>0.5,P<0.05)。HBeAg(-)患者在治疗30 d时血清HBV RNA与HBV DNA呈正相关(r_(s)=0.62,P<0.05),在治疗14 d时HBV RNA与HBsAg水平呈正相关(r_(s)=0.60,P<0.05)。结论:抗病毒治疗时,慢性乙型肝炎患者血清HBV RNA水平随着治疗时间的延长呈下降趋势。患者血清HBV RNA水平与血清HBV DNA、HBsAg、HBeAg在治疗前和治疗初期有明显相关性,随着治疗时间延长,其相关性逐渐减弱。Objective:To investigate the dynamic changes and clinical significance of serum HBV RNA in patients with chronic hepatitis B(CHB)during antiviral therapy.Methods:A total of 62 patients with chronic hepatitis B were treated with Entecavir,the patients were followed up at 0,7,14,30 days and 2,3,6,9,12 months.Quantitative detection of HBV RNA was conducted by TaqMan probe,HBV DNA level was detected by real-time fluorescent quantitative PCR,HBsAg and HBeAg were detected by chemiluminescence,ALT and AST were detected by enzymatic.Results:The serum HBV RNA level showed a downward trend with the extension of treatment time,and the decline rate slowed down after 3 months of treatment,and there was little change after 9 months.The changes of serum HBV RNA between the adjacent monitoring points were all statistically significant(all P<0.05)from 0 day to 6 months.There was no significant difference between the two time points of 6-12 months(P>0.05).Serum HBV RNA in patients with HBeAg(+)was strongly correlated with HBV DNA(r_(s)=0.68,P<0.05),HbsAg(r_(s)=0.64,P<0.05),HbeAg(r_(s)=0.77,P<0.05)in the cardinal line.There was a strong correlation between HBV RNA and HBV DNA during 6 months of treatment(r_(s)>0.50,P<0.05).The correlation between HBV RNA and HBsAg was strong during 3 months treatment(r_(s)>0.50,P<0.05),and it was weak from 6 to 9 months during treatment(r_(s)=0.23,P=0.31;r_(s)=0.28,P=0.23).The correlation between HBV RNA and HBeAg level was strong at each treatment time point(r_(s)>0.50,P<0.05).The correlation between serum HBV RNA and HBV DNA in HbeAg(-)patients at 30 days of treatment was positive(r_(s)=0.62,P<0.05),and the correlation between HBV RNA and HBsAg level at 14 days of treatment was positive(r_(s)=0.60,P<0.05).Conclusion:During antiviral treatment,the serum HBV RNA level of patients with chronic hepatitis B decreases with the extension of treatment time.There is a significant correlation between serum HBV RNA level and serum HBV DNA,HBsAg,HBeAg before and at the beginning of treatment.With the extensi

关 键 词：乙型肝炎病毒 抗病毒治疗 HBV RNA 共价闭合环状DNA 

分 类 号：R512.62[医药卫生—内科学]